Inside Health

By SARITHA RAI

Published: April 7, 2005

Until recently, Robert Beeney, a 64-year-old real estate consultant from San Francisco, lived in pain. But when he finally decided to do something about the discomfort, he spurned all the usual choices.

His doctors advised that he get his hip joint replaced, which his insurer would pay for, but after doing some research on the Internet, he decided to get a different procedure -- joint resurfacing -- not covered by his insurance. And instead of going to a nearby hospital, he chose to go to India and paid $6,600, a fraction of the $25,000 he would have paid at home for the surgery.

This winter, Mr. Beeney flew to Hyderabad, in southern India, and had the surgery at Apollo Hospital by a specialist trained in London, Dr. Vijay Bose. Two weeks later, Mr. Beeney said that he was walking around the Taj Mahal ''just like any other tourist.''

Mr. Beeney's story is becoming increasingly common, as Europeans and Americans, looking for world-class treatments at prices a fourth or fifth of what they would be at home, are traveling to India. Modern hospitals, skilled doctors and advanced treatments are helping foreigners overcome some of their qualms about getting medical treatments in India. Even as politicians and workers' groups are opposing the corporate practice of outsourcing, Mr. Beeney and patients like him are literally outsourcing themselves -- not only to India but also to Thailand, Singapore and other places -- for all kinds of medical services from cosmetic to critical surgeries.

About 150,000 foreigners visited India for medical treatments in the year ending in March 2004, the Confederation of Indian Industry, a leading industry group, said. That number was projected to rise by 15 percent each year for the next several years. The consulting firm McKinsey & Company, a management consultant based in New York, said foreign visitors would help Indian hospitals earn 100 billion rupees (about $2.3 billion) by 2012.

''Health is an emotional issue; it's not like buying a toy or a shirt made abroad,'' said a health care analyst for McKinsey, Gautam Kumra, who is based in New Delhi. ''Nevertheless, you cannot deny the power of economics.''

For some foreigners, like George Marshall, a 73-year-old violin restorer from Yorkshire, England, India's hospitals also offer speedier treatments. Last year, Mr. Marshall said that he started having trouble finishing a round of golf. An angiogram showed two blocked arteries in his heart. With the British National Health Service, Mr. Marshall would have had to wait three weeks to see a specialist, and six more months for coronary bypass surgery. ''At 73, I don't have the time to wait,'' Mr. Marshall said. ''Six months could be the rest of my life.'' Nor could he afford the £20,000 ($38,000) for surgery at a private hospital.

After an Internet search and a chance meeting with a businessman who had gone to India for surgery, Mr. Marshall traveled to the Wockhardt Hospital in Bangalore in southern India last winter. His surgeon, Vivek Jawali, had trained at Great Ormond Street Hospital in London. The men chatted about British politics and Dr. Jawali gave Mr. Marshall his cellphone number and said that he was available 24 hours. A surprised Mr. Marshall said that in the British health system, ''you are just a number, but here you are a person.'' Travel expenses included, the surgery cost him £4,500 ($8,400).

While the number of patients from the West is still small in India, the trend is expected to grow as populations age and health costs balloon. In India, cardiac surgeries cost about one-fifth of what they would in the United States; orthopedic treatments cost about one-fourth as much and cataract surgeries are as low as one-tenth of their cost at American hospitals.

Mr. Kumra, the McKinsey health consultant who also advises the auto industry, noted that a corporation like General Motors spends $5 billion on health care annually. ''When you buy a G.M. car, you are helping G.M. fund $2,000 or $3,000 towards health care costs of retired workers,'' Mr. Kumra said.

To curb spending, corporations are being forced to look at creative low-cost solutions. For instance, radiologists working for Wipro, a software and information technology company based in Bangalore, analyze X-rays and scans from United States hospitals for a fraction of the cost. A diagnostics firm, SRL Ranbaxy, based in New Delhi, tests blood serum and tissue samples from British hospitals. Health specialists say that sending patients to India for treatment is not as unthinkable as it was 20 years ago.

''India is well-positioned to expand into this area of outsourcing,'' said John Lovelock, an analyst in Ontario on global industries for Gartner. ''India is equipped to provide long-term in-patient rehabilitation services, which are very labor intensive, require large facilities and are under serviced in North America,'' he said.

In the last four years, the Apollo Hospital chain, which has 18 hospitals throughout Asia, has treated 43,000 foreigners, mainly from nations in southern Asia and the Persian Gulf. Last year, 7 percent of its 5 billion rupees ($114.9 million) in revenue came from medical services provided to foreigners.